President Pierre Nkurunziza’s decision to run for a third term in April plunged Burundi into a state of unrest not seen since the end of the country’s civil war in 2005. Refugees are arriving in neighboring Tanzania, Rwanda, and the Democratic Republic of Congo (DRC) in the tens of thousands, raising the possibility that the deteriorating security situation could spill over borders.

Further, we believe the presence and engagement of local and international actors in Burundi is crucial in helping to achieve the best possible outcome, not only towards the health and environment issues we initially came here to address, but for the stability of the African Great Lakes region as a whole.

A Rapid Deterioration

Located on the northeastern shores of Lake Tanganyika, Burundi has been relatively peaceful since the end of its civil war. It’s in fact been lauded for its efforts to diffuse ethnic tensions and share political power. As stipulated by the Arusha Accords, which facilitated this peace, Burundi’s constitution allows for a president to sit for only two terms. However, Burundi’s ruling party, the National Council for the Defense of Democracy–Forces for the Defense of Democracy (CNDD-FDD), and its supporters argue that Nkurunziza has only been elected by the people once, having been elected by the parliament for his first term. Nkurunziza running again this year, as he has declared he intends to do, would therefore be constitutionally questionable, and opponents fear it could jeopardize the Arusha Accords and the fragile peace they brought to the region.

Nkurunziza’s decision, announced at the end of April, set off a rapid chain of events, including an attempted coup:

25 April: CNDD-FDD officially announces that Pierre Nkurunziza will run for a third term.

11 May: Belgium suspends aid to Burundi and holds back half of €4 million in funding for the polls themselves.

13 May: While Nkurunziza is in Tanzania at a summit meeting to discuss the crisis, Major General Godefroid Niyombare declares a coup d’état, announcing that the military has removed the president from office.

15 May: After two days of confusion, the Burundi government officially announces that the overthrow attempt has been defeated. Nkurunziza returns to Bujumbura and makes it clear that he remains in charge.

17 May: A cholera outbreak, due to poor sanitation and overcrowding caused by the recent influx of thousands of refugees from Burundi, is confirmed in the coastal Kigoma region in Tanzania and in the Nyarugusu refugee camp inland. Almost 4,500 cases have been reported, with around 30 deaths.

23 May: Zedi Feruzi, leader of the opposition party Union for Peace and Development, is shot dead by gunmen in Bujumbura, Burundi’s capital.

26 May: The UN reports that the cholera situation has slowed, with the daily number of new cases falling from a peak of 915 to under 100.

28 May: The European Union withdraws its election monitors, citing restrictions on the media, excessive force against demonstrators, and the climate of intimidation.

1 June: The UN Central Emergency Response Fund releases $15 million to support up to 200,000 Burundian refugees in Rwanda and Tanzania.

8 June: July 15th is announced as the new date for the presidential election. Opposition parties object, stating that, as not all members of the electoral commission were present (two have resigned and left Burundi), the decision is invalid.

11 June: Under pressure from opposition parties, the UN Special Envoy to the Great Lakes region Said Djinnit quits his role as mediator between rival factions.

15 June: The African Unionrejects the government’s decision to hold the presidential election on July 15th, saying the date should be set by consensus between all parties.

More Displacement

Dealing closely with health, environment, population, and security issues, and the inextricable ties that exist between them, we clearly see that developments in one sector can quickly have knock-on impacts in many others.

The Great Lakes region has always been very fluid with consistently high rates of refugees and population movements, so we are used to providing services to displaced populations. Often, there is very little recognition of the numbers of displaced people ringing Lake Tanganyika. We spoke to a local chief in Makobola, South Kivu (DRC), who explained that he conducts a census of the area every three months to try to keep track. His most recent survey showed a population of 11,000 while the health center census, from just one year prior, showed only 5,500.

There are fears Nkurunziza will invoke ethnicity

We keep our objectives broad, understanding that our methods must be deeply flexible and dynamic in order to be effective in such an environment. For example, in 2013 we catalogued hundreds of indigenous plants in the DRC used by local healers. The project not only helped us understand and protect the biodiversity of the region, but built essential relationships with traditional healers whose trust proved invaluable.

Our population, health, and environment (PHE) work continues, but we’ve also adjusted to the crisis. Over the last few weeks, we have supported international organizations in traveling around Lake Tanganyika to the makeshift refugee camp at Kagunga, Tanzania. We are sharing our local contacts within the Tanzanian Ministry of Health and other departments to help bridge communication gaps amongst actors who need to be coordinated. And we are currently hosting Médecins Sans Frontières Switzerland at our compound in Kigoma. Our staff speaks all the languages of the basin – of which there are dozens – and many of them have been refugees themselves, so they can offer deep empathic support along with our supply chains and logistical know-how.

What Next?

We will continue to have eyes and ears on the ground as the situation evolves in Burundi and its neighbors. Key developments to track will be the return to political dialogue and how (and whether) the East African Community and African Union will engage positively; the United States’ appointment of a new special envoy for the Great Lakes Region and the DRC to replace Russ Feingold (this vacancy is deeply damaging at a time like this); if the UN will replace Said Djinnit in the position of mediator for the crisis; and Pierre Nkurunziza’s next steps. There are fears Nkurunziza will invoke ethnicity and/or be forced to stand down if the pressure becomes too great.

Whatever happens, we are committed to the communities living around Lake Tanganyika and our integrated approach. In some ways, PHE was made for fluid situations like this. We have worked hard to build trust with communities and offer a suite of interventions that touch on people’s immediate needs – reproductive health, environmental management, alternative livelihoods. This is no less true during a time of instability.

Amy Lehman is founder and CEO of LTFHC/WAVE, an NGO engaging in health systems building in the Lake Tanganyika Basin and policy work throughout the African Great Lakes region. Hannah Muirhead works on policy for the organization.

Sources: UN High Commission on Refugees.

Photo Credit: Protestors against a third term for President Pierre Nkurunziza near the town of Ijenda, Burundi, June 3, courtesy of Goran Tomasevic/Reuters.